부산대학교 도서관

BACKGROUND:: In decentralized sites, with fewer resources and a high prevalence of advanced HIV, the effectiveness of the new short-course, bedaquiline-based regimen for rifampicin-resistant and multidrug-resistant tuberculosis (RR/MDR-TB) is not well-described. SETTING:: Adults with pulmonary RR/MDR-TB initiating the short-course regimen in KwaZulu-Natal, South Africa were prospectively enrolled at a decentralized program that integrated person-centered TB care. METHODS:: In addition to standard of care monitoring, study visits occurred at enrollment and months 1, 2, 4, 6 and 9. Favorable RR/MDR-TB outcome was defined as cure or treatment completion without loss to follow-up, death or failure by treatment. In patients with HIV, we assessed ART uptake, virologic and immunologic outcomes. RESULTS:: Among 57 patients, HIV was present in 73.7% (95% CI: 60.3—84.5), with a median CD4 count of 170 cells/mm (intraquartile range (IQR) 49—314). A favorable RR/MDR-TB outcome was achieved in 78.9% (CI: 67.1—87.9). Three deaths occurred, all in the setting of baseline advanced HIV and elevated viral load. Overall, 21.1% (95% CI: 12.1–32.9) experienced a severe or life-threatening adverse event, the most common of which was anemia. Among patients with HIV, enrollment resulted in increased ART uptake by 24% (95% CI: 12.1–39.4%), a significant improvement from baseline (P=0.004); virologic suppression during concomitant treatment was observed in 71.4% (n=30, 95% CI: 55.4-84.3). CONCLUSION:: Decentralized, person-centered care for RR/MDR-TB in patients with HIV using the short-course, bedaquiline-based regimen is effective and safe. In patients with HIV, enrollment led to improved ART utilization and reassuring virologic outcomes.